What are the Zakys, Use, NICU Process Standard, Comparison

Only with the Zakys, each and every baby receives evidence-based developmental care and the highest level of standardcare, from birth and around the clock, regardless of the baby's size, developmental stage, or medical condition.

Each baby uses only one pair of Zakys on the bed and during all hospitalization, virtually replacing all other items for developmental care. The Zakys are multifunctional and ergonomic that always provide all the features needed at any time to provide physical, physiological, psychological, and neurological developmental support to the baby.

You only learn how to use the Zaky once, devoting the rest of the training time to learning about the developmental stages, and how to meet the patients' needs.

The inventory and storage needs are downsized to one product, optimizing order management, decision making, quality control, and infection control.

It takes little time to make parents proficient in using The Zakys, helping them become involved in an effective manner, and supporting them in what could very well be one of the most traumatic time of their lives.

I don't recommend many products - the Zaky is one of the few that I endorse with confidence because I see babies relaxed and comfortable with this support when they cannot be in the arms of their parents. A great invention. Thank you.”

Inga Warren, London (UK), International NIDCAP Trainer

What is The Zaky?

Instructions
/Warnings

Process Standard

Comparison against others

What are The Zakys?

The award-winning The Zaky is a human hand mimetic and pediatric bolster support device ergonomically designed to simulate the shape, warmth, weight (500 grams), and touch of the parents’ hands and forearms. Parents are encouraged to scent The Zaky by placing it directly on the skin (chest or neck) to provide more effective family centered developmental care to hospitalized infants on the bed/incubator.

By using The Zakys, we not only provide a simulation of the presence of the parent, as the original The Zaky did for Zachary 13 years ago. The Zaky now not only simulates the presence of the parent, but it provides proper positioning to support the musculoskeletal development, provides comfort, containment, boundaries, a sense of security, and all that combined results in babies are soothed, more relaxed, calmer, and all these is known to promote sleep.

Only one universal size with the shape of right and left hands are available. The Zaky is designed to provide full body support, to aid with prone/supine/sidelying positioning, to provide adjustable weight, containment, to aid with soothing and with providing constant boundaries, to aid with developmental support, and to aid with olfactory stimulation and with attachment/bonding when it is scented by the parent prior to providing it to the infant.

The Zakys are the only evidence-based and ergonomically design device that provides family centered developmental care support to every infant: They are the only devices with clinical evidence that suggests that for the babies in the stury it significantly decreased apnea/bradycardia and significant improved self-regulation and stress behaviors. In fact, the babies using the Zakys Maternally Scented had ZERO apnea/bradycardia events in this randomized clinical research.

Design:

The shape is familiar and therapeutic: hand/forearm that weighs 500 grams.

Its universal size: equivalent to a woman's medium size hand and forearm, the same size is used for every baby, regardless of positioning, size, medical condition, age, and/or developmental stage. No need for small/medium/large or light/medium/heavy.

Ergonomic design researched and developed for 3.5 years before releasing it to the market. Invented by a PhD in ergonomics engineering.

Adjustable weight to use on the top of the baby: Displace all the filling and use only the weight of the fabric for micropreemies. 6-7 lb babies can take the full weight of the Zaky (500 grams).

Safety:

Fully Washable: includes the washing bag - wash/dry without disassembly.

Recyclable: wash and reuse.

Scent of the parents by placing them directly on their skin (chest or behind the neck) for at least one hour.

Warm and soft: place the Zakys in the towel warmer or dryer to get it warm.

Infection Control: many hospitals that have zero incidents of infections use the Zakys as standard for developmental care.

Soft and soothing material: antipilling microfleece immediately is soothing for the baby.

Safe materials: the filling is made out of a special type of plastic in the shape of smooth plastic micro-spheres that are antimicrobial, antiallergenic, antifungal, washable, quiet, and do not get hot under a heating source.

Quiet operation: filling is quiet when the Zaky is moved. This is important for the NICU baby's developmental support.

Usability:

Comprehensive care: a pair of Zakys virtually replace all positioners, transitional items, nests, bonding items, and soothing devices. The Zakys are ergonomically designed to help provide comprehensive physical, physiological, psychological, neurological developmental and family-centered care to hospitalized neonates ensuring the best possible quality of life (for a lifetime) and an effective inclusion of the baby into his/her family. All without medication/stimulants, invasive procedures, or expensive equipment .

Individualized, and constant level of care for every baby, regardless of size, age, medical condition, or developmental stage, including NAS and end-of-life/palliative care.

Ideal for any position: the same Zakys help with prone, sidelying, supine position, and to use on top, bottom, around, or away from the baby.

Bolster Support: place the Zaky vertically with the hand on the top, and fold the hand to make a firm but flexible roll

Versatility:

The most effective transitional device: To help babies with the transition from hospital to the house, and to continue developmental care at home, the healthcare professionals must train the parents to correctly use the Zakys in the car seat, to continue providing developmental care during wake periods, and the "back-to-sleep program", as they teach any other intervention to be performed at home. Up to 6 months of age, the Zakys must be used under constant supervision.

More effective transport: give the Zakys to the mom to scent (place on the chest or behind the neck) while the baby is being prepared for transport. Take the Zakys with the baby.

Parent-Child Centered Features

Parent-Child centered device: Originally made for Zachary (hence the name), The Zaky was invented to help Yamile leave the hospital every night leaving something of her behind (the simulation of her hands and her scent). The baby feels the scent and love of the mother and father constantly (helping with strengthening attachment/bonding), even when they are not present and they, in turn, feel more confidence and secure to perceive it as an extension of them that contributes to the 24/7 development of the baby. Parents leave the scented Zakys with the baby at all times (scent it by placing it on the chest or behind the neck for at least one hour)

Complement for Kangaroo Care: Place the Zaky behind the neck of the parent during kangaroo care to help support the head while scenting the Zakys to leave with the baby at the end of the session.

Our call for arms is to decrease or even eradicate bradycardia and apnea of prematurity. Current knowledge suggests that these events are common, often treated by prescribing caffeine/stimulants to keep the baby awake or by waking them up with tactile stimulation. With research about Kangaroo Care and The Zaky, we are shedding light to the fact that they are not caused by the immaturity of the brain, heart, and respiratory system but because of poor environmental conditions in the NICU.

Clinical research shows that Kangaroo Care and The Zakys significantly reduce life-threatening apnea and bradycardia and significantly improve self-regulation and organization, needed for brain development. All without expensive equipment, medication/stimulants or invasive procedures

While babies may "outgrow" apnea and bradycardia, the effects of sleep deprivation, especially neurological deficiencies, may never be outgrown."

Two Zakys are virtually all you need to provide effective and ergonomic developmental care to all NICU babies.

The Zakys may be used in any number of ways to position and comfort, calm, console and reassure the neonate:

The Zaky can be positioned around the agitated or restless neonate to provide containment, and promote hand-to-mouth activities. Containment will reduce overall energy expenditure and oxygen consumption, and encouraging hand-to-mouth activity will enhance development of the neurological system.

The best results are achieved when the Zakys are scented by the mother, as she is the only known source of security, and the father, the new source of security. Scent them by placing them on the chest or behind the neck for at least one hour.

Washing Instructions:

Each of The Zaky hands includes a washing bag. To wash/dry place The Zaky (no disassembly required) inside the washing bag and follow the same laundry protocol as the one used for the patients' clothing. No sterilization needed. Parents appreciate washing The Zakys at home. Rule of thumb, wash once a week unless soiled before.

Olfaction:

The Zaky is a device that can be used to support maternal infant separation through the provision of maternal scent, warmth, and weight.

This intervention simulates the uterus or therapeutic holding.

It takes time to scent and warm the Zaky.

Maternal odor signature can be obtained by placing the Zaky in areas on the mother’s body that capture natural maternal odor similar to the intrauterine environment.

Placing the Zaky behind the neck under the hair or between the breasts for a minimum of one hour or longer will provide an adequate level of maternal scent.

The mother should be encouraged to use her natural scent, which is unique and reproducible, and not distort the odor with artificial products such as perfume, deodorant, or lotion.

Additional maternally scented Zaky’s can be stored in the infant isolette in a zip lock bag marked with freshly scented on “date” and stored for 72 hours.

In the event of soiling the Zaky can be placed in the laundry and a recently scented Zaky can be placed in the infants micro environment.

Scenting Instructions:

Scenting is not mandatory, however, it is extremely recommended that the mother (and father) scent the Zakys to decrease mother/child separation anxiety and promote attachment. The scent lasts until the next wash. Each time The Zaky is washed, it needs to be re-scented. Parents place The Zaky directly on the skin (chest or behind the neck work well) for at least one hour - or sleep all night with it. Also, during Kangaroo Care, one hand of The Zaky can be placed behind the neck (under the hair), it not only gets scented but it also helps stabilize the head of the parent.

Warming The Zaky:

Infant thermoregulatory requirements vary and health care providers and parents must be aware of isolette needs prior to applying the Zaky to an infant whose thermoregulatory needs fluctuate widely.

Additionally the Zaky position cannot impede flow of the air in the isolette.

How this translates into practice is when you have an infant who is requiring high levels of isolette heat for thermoregulation and homeostasis it is necessary to warm the Zaky to a similar temperature prior to placing it next to the infant.

If the infant is in skin to skin care this may be accomplished by placing the Zaky in the skin to skin top with the mother and placing it next to her breast tissue on the outside of her breast in the top or by using the isolette to warm it when the baby is in skin to skin care.

Similar to any device used near an infant who has high thermoregulatory needs the product must be heated to the infants isolette temperature to avoid compromising infant thermoregulation and stability.

Warnings and Therapeutic Considerations:

Adjust the weight to be placed on top of a baby: Displace the filling of the Zaky so that the weight on the baby is selected according to his/her size and medical condition. For example, babies weighing 500-600 grams need only the weight of the fabric (displace all the filling by holding it vertically by the hand; or displace the filling from the middle of the Zaky) Infants of 5-6 lbs can take the entire weight of the Zaky.

Do not use The Zakys on the face.

Wash/Dry the Zakys in the washing bag provided. Warm them in the dryer or towel warmer.

Do not use The Zakys for any other purpose other than the ones recommended by the manufacturer.

As with any other intervention to be performed at home, staff needs to ensure that the parent is proficient and knowledgeable about developmental care and the use of the Zakys.

Do not leave baby unattended when using the Zakys at home.

For babies younger than 6 months old, the Zakys will provide an environment so the baby falls asleep, however, the Zakys must be removed once the baby is asleep and/or if parents are not around, unless otherwise recommended by the pediatrician. Reasons some pediatricians may recommend the Zakys to stay with the baby include: the baby needs developmental care at home, s/he is not sleeping (thus not developing the brain), wakes up too much, has colic, experiences separation anxiety, is getting a flat head, must sleep on the side, etc.

Photos

The same Zakys are used in any position, providing nesting, boundaries, containment, the parents' scent. They virtually eliminates the need for swaddling, replaces all positioners, transitional items, bonding/attachment devices, and soothing/sleep aids. One universal size is used for every baby independent of size, medical condition, age, or developmental stage.

PURPOSE
The Zaky is a patented device readily available in the market that mimics the shape, weight, warmth and keeps the scented odor of the infants' mother. It should be scented for a minimum of one hour with direct skin to skin contact free of perfumes, lotions or chemicals. It can be scented anywhere on the mother and should be placed flat with direct skin to skin contact. On the mother it may be placed between the breasts, against the back of the neck. It may be left on the infant and changed with infant bathing, isolette change or when soiled. Once removed it will be placed in MCCG the laundry in the white washing bag it was placed in prior to implementing therapy to prevent it from being harmed by other products in the wash. Clean Zakys will be stored in the unit near the clean bed covers, blankets and infant clothing.
To outline the results of our nursing research conducted in the Neonatal Intensive Care Unit 2009-2010 entitled Give Them a Hand to develop their brain: The Effect of a Maternal Simulated Intervention on Physiologic and Developmental Behaviors of 24-34 Week Gestation Infants In a Level III Neonatal Intensive Care Unit as it relates specifically to the use of The Zaky.
It is not the intention of this policy to outline all developmental strategies the support the growing preterm infant.

POLICY
Neurodevelopmental care is a broad term used for nursing practices, physical environmental elements and family involvement philosophies that may favorably impact the neurodevelopment of the premature newborn. It includes promotion of positioning strategies, gentle touch, modulation of light and sound exposure, increased parental involvement as well as an emphasis on the need to preserve sleep. There has been a recognized need to systematically address these issues. The decision to implement these practices is base upon evidence derived from a rapidly evolving body of scientific knowledge. This is found not only in the medical and nursing literature but also in the fields of neuroscience, neurobiology, neurophysiology, developmental psychology and developmental psychobiology.
The somatesthetic (touch) system includes several types of sensory input including touch, pressure, and pain among others. The neural pathways for movement and position stimuli are intact as early as 23-24 weeks gestation. These systems have early endogenous stimuli for axon growth and targeting. They also set the patterns for the connections that ultimately lead to the cortex. The in- utero environment of the fetus provides somatesthetic, kinesthetic (movement) and proprioceptive position) feedback. Swaddling and containment of the infant with general flexion of the extremities and trunk use a general approximation of the effect. Swaddling has a long history basis in practice. 1 It is a means to promote sleep with decreased awakenings during quiet sleep. 2, 3 and longer periods of REM sleep. 4 It also appears to improve self regulation, diminished stress response 5 and a decrease in arousal level, 6 including decreased crying, 7-9 and may promote neuromuscular development in the preterm infant. 10 ^Top

EXPOSURE TO MOTHER'S SCENT
Four major anatomic areas are responsible for human smell: the olfactory system, the vomeronasal organ, the trigeminal nerve and the terminal nerve. They all interact to provide varying sensitivities to chemostimulants. The vomeronasal organ is designed to function primarily in late fetal life, and may lose function prior to birth, as it is not detected in adults. The olfactory system is clearly functional by 28 weeks gestation, with the trigeminal nerve and vomeronasal organ effective prior to 24 to 25 weeks. 11
The newborn infant has an inherent preference for amniotic fluid odors, breast milk and their own mothers' odor signature.12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 Within days after birth, olfactory preferences seem to be reinforced by exogenous cues associated with the mother's unique body odor and breast milk characteristics,22, 23, 24, 25, 26, 27 which may be translated into improved non-nutritive sucking.28, 29
These familiar odors also seem to have an adjunctive calming or soothing effect compared to non-familiar odors or no odors during venipuncture or heel lancing procedures,30, 31 with the stress of maternal separation or as a soothing tool.29, 32
The ultimate goal of intervention strategies in the NICU is to facilitate and promote infant growth and development. In the NICU caregivers achieve this goal by altering the environmental and care giving stressors that interfere with physiologic stability; promoting individual neurobehavioral organization and maturation by identifying and facilitating stable behaviors and reducing stressful behaviors, conserving energy, teaching parents to interpret infant behavior, and promoting infant-parent interaction and care giving. Establishing biorhythmic balance and physiologic homeostasis is necessary for survival and is enhanced by a sensitive, responsive NICU environment. An unresponsive environment may be so stressful to the preterm infant that apnea, bradycardia, and other physiologic instabilities may severely compromise and prolong recovery.
Hospitalized infants, especially those with prolonged stays, may exhibit classic signs of institutionalized infants or infants suffering from maternal deprivation. Our goal is to prevent this maladaptive behavior by altering the NICU to be more developmentally appropriate and responsive for infants. Normalizing the environment begins with an assessment of the stimulation to which the individual infant is exposed.
The goal of minimal stimulation is to deliver quality therapeutic and supportive care in the least stressful manner. This will reduce the neonate’s energy expenditure, preventing the breakdown of the neonate’s natural defenses to achieve as normal a neurological outcome as possible.
The results of our research “Give Them a Hand” are promising in that use of the maternal simulated intervention (Zaky) demonstrated a positive outcome in the population studied. Organized physiologic indicators were improved in the scented Zaky group as evidenced by cardiorespiratory stability, color, less apnea and bradycardia and feeding tolerance. Organized behavior indicators were smooth, synchronous movements, good tone, flexed extremities, well defined sleep and wake states, exhibiting self quieting behaviors, and attentive behaviors. Additionally, the finding of no apnea and bradycardia in our maternally scented experimental group has the potential to augment current care. Using the maternally scented Zaky for positioning may be a low cost intervention that can be easily implemented as a standard part of care for the premature infant in the NICU. Findings from this study support the need for additional research. ^Top

ASSESSMENT
Assessments related to the use of The Zaky include: correct infant positioning, visibility of the temperature probe, inspection of the product for soiling or need for replacement, availability of the mother for maternal scenting and attention to infant behaviors.^Top

INTERVENTION
There are many available strategies for the NICU nurse to evaluate when selecting interventions and devices to augment and support the growing preterm infant. The optimal environment for the developing fetal brain is the womb and the NICU environment is less favorable and often hostile. Use of The Zaky when weighing potential risk against benefit has some additional justification for use from our research. It is our responsibility to ensure that our existing environment is at the least non disruptive, and optimally supportive for normal brain development. It is in this context that our unit provides this intervention as a general recommendation.

REPORTABLE CONDITIONS

Notify physician if stress signals are not relieved by interventions.

Discuss need for developmental team evaluation and support of the plan of care.

Parents Continue Developmental Care With The Same Product At Home After Proper Training

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Training Concentrated On Developmental Stage Of The Baby Not On How To Use What Combination Of Tools

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Infection Control

Product Name:

The Zakys™

Bendy Bumper™

Frederick T. Frog™

Prone Plus™

Snuggle Up™

Snoedl™

Dandle ROO™

Dandle ROO Lite™

Dandle WRAP™

Dandle PAL™

Z flo®

Washable Full or Parts

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Includes Washing Bag

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No Disassembly Required

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Management and Supply Chain

Product Name:

The Zakys™

Bendy Bumper™

Frederick T. Frog™

Prone Plus™

Snuggle Up™

Snoedl™

Dandle ROO™

Dandle ROO Lite™

Dandle WRAP™

Dandle PAL™

Z flo®

Reduced and Minimized Inventory and Storage Space Needed

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Always the right size device is available

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Simplified Ordering Management, Supply Chain

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Simplified Training and Quality Control

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More Accurate Forecasting, Planning, Procurement and Logistics

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Multifunctional, Multipurpose Device Used By Every Patient in the NICU To Provide Comprehensive, Evidence-Based Family-Centered Developmental Care.

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(*)=Company and product names are Registered Marks of each individual company. Nurtured by Design is independent from any other company listed in this comparison. This comparison is for information only.